Abstract
BackgroundThe reasons why patients decide to consult a general practitioner vary enormously. While there may be individual reasons for this variation, the family context has a significant and unique influence upon the frequency of individuals' visits. The objective of this study was to explore which family factors can explain the differences between strikingly high, and correspondingly low, family consultation rates in families with children aged up to 21.MethodsData were used from the second Dutch national survey of general practice. This survey extracted from the medical records of 96 practices in the Netherlands, information on all consultations with patients during 2001. We defined, through multilevel analysis, two groups of families. These had respectively, predominantly high, and low, contact frequencies due to a significant family influence upon the frequency of the individual's first contacts. Binomial logistic regression analyses were used to analyse which of the family factors, related to shared circumstances and socialisation conditions, can explain the differences in consultation rates between the two groups of families.ResultsIn almost 3% of all families, individual consultation rates decrease significantly due to family influence. In 11% of the families, individual consultation rates significantly increase due to family influence. While taking into account the health status of family members, family factors can explain family consultation rates. These factors include circumstances such as their economic status and number of children, as well as socialisation conditions such as specific health knowledge and family beliefs. The chance of significant low frequencies of contact due to family influences increases significantly with factors such as, paid employment of parents in the health care sector, low expectations of general practitioners' care for minor ailments and a western cultural background.ConclusionFamily circumstances can easily be identified and will add to the understanding of the health complaints of the individual patient in the consulting room. Family circumstances related to health risks often cannot be changed but they can illuminate the reasons for a visit, and mould strategies for prevention, treatment or recovery. Health beliefs, on the other hand, may be influenced by providing specific knowledge.
Highlights
The reasons why patients decide to consult a general practitioner vary enormously
The health interviews show that respondents from lowering-effect families have fewer expectations of general practitioners' care in cases of minor ailments than respondents from raising-effect families (Table 3)
The results indicate that striking variations in family consultation rates can be explained, especially by the family health status, and by family circumstances such as economic status and number of children, as well as socialisation factors such as health knowledge and family beliefs
Summary
The reasons why patients decide to consult a general practitioner vary enormously. While there may be individual reasons for this variation, the family context has a significant and unique influence upon the frequency of individuals' visits. Shared circumstances refer to a collective social, physical and financial context in which opportunities for health, or threats to health occur Shared circumstances such as the kind of insurance [14] or family size [15] can explain similarities in consultation rates with general practice among individual family members. Earlier research showed that mothers more often consult general practice with their first born than with subsequent children [14] This may indicate that parents of larger families are more experienced in health care matters, resulting in fewer consultations for all members. The family context may influence consultation behaviour in such a manner that, for example, from a family viewpoint, the decision not to visit the general practitioner is a logical one.
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